Rapid Response: Real Time Capturing of Significant Organisms by a Simple Computer Based Tracking System

BACKGROUND/OBJECTIVES: At our medical center the Microbiology lab (Micro) notifies Infection Control (IC) of all significant organisms (SO) as Vancomycin Resistant Enterococcus (VRE) Extended Spectrum Beta Lactamase (ESBL) Clostridium difficile (Cdiff) and Resistant Gram Negative Bacilli (RGNB). The annual report for 2004 by Micro on SO prevalence disclosed that there had been 12 patients (Pts) with Cdiff from one clinical area suggesting a missed opportunity to investigate an outbreak. We realized that the IC computer program used for data collection did not identify clusters of like SO or provide an alert system for rapid intervention. Our goal was to develop an inexpensive, visual, real time tracking system that would rapidly identify SO and allow prompt intervention by Infection Control Practioners (ICP). METHODS: Our data analyst (DA) created an electronic spread sheet that color coded each SO by time and place and linked this to a Pts data sheet of IC relevance. The DA updated the system each time Micro reported a SO. The electronic data base was accessible to the ICP at any time. ICP placed the Pt on isolation and initiated an investigation when ≥2 like SO occurred in the same unit in one week. RESULTS: SO identified from March through Novermber 2005 are as follows: VRE 101, Cdiff 64, ESBL 37 and RGNB 34. Investigation of clusters showed the following 1) ESBL: 10 Pts in a 4 week period in the Intensive Care Units (ICUs). Strain characterization showed them to be multiple strains except in 2 Pts. 2) VRE: 18 over 7 months were from the Bone Marrow Transplant (BMT). Strain characterization showed two clonal patterns. 3) RGNB: 2 Pts from an ICU with a shared strain. 4) Cdiff: 5 were in one pediatric unit concurrently. 5) There was inconsistent understanding by employees on the need for soap/water hand hygiene with Cdiff. INTERVENTIONS: 1) IC collaborated with informatics service to include an IC active health issue field that allows IC to identify the Pts needing isolation for all admissions. 2) Developed a unique signage for Cdiff that identifies the need for using soap and water. 3) Created a process improvement team in BMT to address IC needs. 4) Increased the visibility of ICP on wards to provide continuous education of Pts/family and staff and share data from investigations with the staff. CONCLUSIONS: An inexpensive, computer based tracking system maintained by the DA allows the ICP to expand surveillance of SO, institute outbreak investigations promptly, instutute interventions based on findings and educate Pts/families and staff on IC practices. It also served to heighten the importance of antibiotic pressure on the evolution of SO.